Fill and Sign the Form N 1a Sec

FL-401 ATTORNEY OR PARTY WITHOUT ATTORNEY TELEPHONE NO.: ATTORNEY FOR (Name): FOR COURT USE ONLY SUPERIOR COURT OF CALIFORNIA, COUNTY OF STREET ADDRESS: MAILING ADDRESS: CITY AND ZIP CODE: BRANCH NAME: PETITIONER/PLAINTIFF: RESPONDENT/DEFENDANT: APPLICATION FOR DISBURSEMENT AND ORDER FOR DISBURSEMENT FROM CHILD SUPPORT SECURITY DEPOSIT (Family Law–Uniform Parentage)CASE NUMBER: APPLICATION FOR DISBURSEMENT FROM CHILD SUPPORT SECURITY DEPOSIT 1. The u nders ig ned is e ntit le d t o r e ce iv e c h ild s u pport p aym ents . A d eposit h as b een e sta blis h ed t o s e cu re p aym ent o f t h e c h ilds u p port. T he s u pp ort is m ore t h an 1 0 d ays la te , a s f o llo w s:A m ount d ue a s c h ild s u pport Date d ue Am ount p aid Am ount d ue Tota l a m ount d ue : 2. I r e qu est t h e c o urt t o o rd er d is b urs e m ent o f t h e a m ount d ue f r o m t h e c h ild s u pport s e cu rit y d eposit .I d ecla re u nder p e nalt y o f p erju ry u nder t h e la w s o f t h e S ta te o f C alif o rn ia t h at t h e f o re goin g is t r u e a nd c o rre ct.D ate : (TYPE OR PRINT NAME) (SIGNATURE) A copy of this application must be served on the obligor and proof of its service attached to the original that is filed with the court.O RDER F O R D IS B URSEM EN T F R O M C HIL D S U PPO RT S EC URIT Y D EPO SIT A ND O RDER T O R EPLE N IS H F U NDS 3. The following financial institution (name): shall pay the following amount: $ to the following person who is entitled to receive payment of childsupport (name): 4. The obligor (name): shall replenish the child support security depositby depositing the following amount: $ not later than (date): The original evidence of replenishment shall be filed with the court. A copy of the evidence of replenishment shall be served on the person entitled to receive payment of the child support.Date: JUDGE OF THE SUPERIOR COURT 5. I certify that the foregoing order is a copy of the original on file with the court. Date: Clerk, by , Deputy = page 1 of 1 Form Adopted by for Manditory Use Judicial Council of CaliforniaFL-401 [Rev. January 1, 2003]APPLICATION FOR DISBURSEMENT AND ORDER FOR DISBURSEMENT FROM CHILD SUPPORT SECURITY DEPOSIT Family Code, §§ 4570–4573 electronic form  2002 WWW.LawCA.com Law Publishers Form Adopted by Rule 1285.29 Judicial Council of California 1285.29 [New January 1, 1995] APPLICATION FOR DISBURSEMENT AND ORDER FOR DISBURSEMENT FROM CHILD SUPPORT SECURITY DEPOSIT (Family Law– Uniform Parentage) Family Code, §§ 4570-4573 Electronic form (c) 1998 Fresno LaserGraphics, Inc.